European Spine Journal最新文献

{"title":"\"Beyond the incision\": A case-control study on IV and epidural pre-emptive analgesia in lumbar spine surgery.","authors":"Akhil Xavier Joseph, Alia Vidyadhara, Anjana Kashyap, Abhishek Soni, Balamurugan Thirugnanam, Madhava Pai, Vidyadhara S","doi":"10.1007/s00586-025-09143-x","DOIUrl":"https://doi.org/10.1007/s00586-025-09143-x","url":null,"abstract":"<p><strong>Introduction: </strong>Effective pain management in lumbar spine surgery is critical to enhancing postoperative recovery and minimizing complications. Preemptive analgesia, administered either intravenously or epidurally, has shown promise in controlling pain; however, limited data exist comparing the two routes directly to determine the optimal approach for lumbar procedures.</p><p><strong>Purpose: </strong>To evaluate and compare pain control efficacy, recovery outcomes, and postoperative complications between IV and epidural preemptive analgesia routes in lumbar spine surgeries.</p><p><strong>Methods: </strong>A prospective, double blinded study comparing the efficacy of intravenous (IV) and epidural preemptive analgesia in patients undergoing lumbar spine surgery. Patients undergoing lumbar spine surgery were divided into three groups based on the analgesia route: Epidural, IV and Control respectively. Pain scores, analgesic consumption, and recovery profiles were assessed postoperatively. Statistical analyses, including ANOVA and Chi-square tests, were used to evaluate differences in pain control and recovery outcomes between groups.</p><p><strong>Results: </strong>VAS scores at 4, 8, 12, and 24 h postoperatively were significantly different among groups (p < 0.0001). Group 1 (epidural) reported scores of 5.13 ± 0.86, 4.97 ± 0.93, 3.23 ± 0.94, and 3.17 ± 0.91; Group 2 (IV): 6.79 ± 1.29, 5.07 ± 0.92, 3.79 ± 1.18, and 3.21 ± 0.94; Group 3 (control): 8.92 ± 0.84, 6.96 ± 0.84, 5.82 ± 0.81, and 5.55 ± 0.50. Time to first analgesic was 26.00 ± 9.77 min (G1), 25.00 ± 9.82 min (G2), and 10.41 ± 3.51 min (G3) (p < 0.0001). Total 24-hour consumption: fentanyl- G1: 32.20 ± 4.99 mcg, G2: 30.90 ± 8.78, G3: 62.55 ± 12.34; paracetamol- 1.00 ± 0.00, 1.03 ± 0.19, 2.00 ± 0.00 g; ketorolac- 50.00 ± 0.00, 51.72 ± 9.28, 100.00 ± 0.00 mg; tramadol- 45.00 ± 15.26, 49.66 ± 16.58, 73.47 ± 15.08 mg (all p < 0.0001).</p><p><strong>Conclusion: </strong>This study fills a critical gap by directly comparing IV and epidural pre-emptive analgesia in lumbar spine surgery, providing insights for clinical decision-making. Findings suggest IV analgesia offers comparable pain control to epidural, presenting a safer alternative with fewer procedural risks. Results hold valuable implications for optimizing perioperative care.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of the correlation between paraspinal muscles fat infiltration and vertebral bone quality in patients with lumbar degenerative diseases.","authors":"Siyi Wang, Yongdi Wang, Zhe Wang, Youwei Ai, Qian Chen, Yize Zhao, Ruibang Wu, Yong Huang, Ce Zhu, Limin Liu, Ganjun Feng","doi":"10.1007/s00586-025-09142-y","DOIUrl":"https://doi.org/10.1007/s00586-025-09142-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to comprehensively evaluate the association between paraspinal muscle fat infiltration (FI) and three MRI-based vertebral bone quality indicators-Vertebral Bone Quality (VBQ), Modified VBQ (MVBQ), and Endplate Bone Quality (EBQ)-in patients with lumbar degenerative diseases (LDD), and to compare their diagnostic and prognostic implications.</p><p><strong>Methods: </strong>A retrospective analysis included 261 patients undergoing transforaminal lumbar interbody fusion (TLIF) for LDD. Paraspinal muscle parameters-total cross-sectional area (TCSA), functional CSA (FCSA), relative FCSA (rFCSA), and fat infiltration rate (FIR)-were obtained from preoperative MRI. VBQ, MVBQ, and EBQ scores were also calculated. Patients were stratified into high and low FI groups based on FIR quartiles. Correlation and multivariable regression analyses were performed, and diagnostic performance was assessed using Receiver Operating Characteristic (ROC) curves, Clinical outcomes (Oswestry Disability Index (ODI), Visual Analogue Scale (VAS)) were followed up for 2 years.</p><p><strong>Results: </strong>Patients with high FI exhibited significantly elevated VBQ (3.41 vs. 3.01, p < 0.001), MVBQ (3.47 vs. 2.91, p < 0.001), and EBQ (3.31 vs. 2.97, p = 0.001) scores compared to the normal FI group. FIR correlated positively with all bone quality indices, with the strongest association for MVBQ (r = 0.432, p < 0.001). MVBQ demonstrated superior diagnostic performance (AUC = 0.70) compared to VBQ (AUC = 0.64) and EBQ (AUC = 0.53). At 2-year follow-up, high FI patients had worse ODI scores (11.61 vs. 10.57, p = 0.031), though no differences in VAS were observed.</p><p><strong>Conclusion: </strong>Our study established a significant association between paraspinal muscles FI and the bone quality of various regions of the vertebrae, as well as prognosis undergoing surgery for LDD patients. MVBQ may serve as a reliable and practical preoperative marker for musculoskeletal degeneration in patients with LDD, guiding individualized risk stratification and rehabilitation planning.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural course of moderate adolescent idiopathic scoliosis: a mean 25-year follow-up study.","authors":"Masayuki Ohashi, Kei Watanabe, Toru Hirano, Kazuhiro Hasegawa, Hideki Tashi, Keitaro Minato, Yohei Shibuya, Masayuki Sato, Mio Kubota, Hiroyuki Sekimoto, Hiroyuki Kawashima","doi":"10.1007/s00586-025-09135-x","DOIUrl":"https://doi.org/10.1007/s00586-025-09135-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine the natural course of moderate adolescent idiopathic scoliosis (AIS) in terms of curve progression and health-related quality of life (HRQOL).</p><p><strong>Methods: </strong>The inclusion criteria were nonoperatively treated patients with AIS who had a major curve between 30° and 40° at skeletal maturity (Risser ≥ 4) and age ≥ 30 years at the survey. Fifty-eight patients (55 women) were included (follow-up rate, 37.4%). The mean age was 14.2 years at skeletal maturity and 39.9 years at the survey, with a mean 25.7-year follow-up. The HRQOL scores were compared with age- and sex-matched healthy volunteers (n = 112).</p><p><strong>Results: </strong>The median magnitude of the major curve was 36.5° at skeletal maturity (n = 58), 40° at the age of 18 years (n = 30), and 45.5° at the survey (n = 47) with a progression rate of 0.5°/year. The major curve at the survey was over 50° in 46.7% of patients, 82.4% of whom had already had major curves ≥ 40° at the age of 18 years. Despite their curve progression, patients demonstrated comparable HRQOL scores with control participants, except for the SRS-22 self-image score (AIS 2.8 vs. Control 3.4, p < 0.001).</p><p><strong>Conclusion: </strong>Moderate AIS progressed slowly but significantly throughout adulthood. Over 40% of the curves were > 50° during the mean 25-year follow-up period. Although the HRQOL scores of adult patients with moderate AIS at skeletal maturity were comparable with those of the controls, their cosmetic concerns could not be disregarded. Therefore, moderate curves, especially those ≥ 40° at the age approximately 18 years, warrant long-term follow-up.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the Letter to the Editor concerning \"The CASINO trial: surgical versus conservative management in patients with cervical radiculopathy due to intervertebral disc herniation: a prospective cohort study\" by Gül A, et al. (Eur Spine J [2025]: doi: 10.1007/s00586-025-09045-y).","authors":"Azra Gül, Carmen Vleggeert-Lankamp","doi":"10.1007/s00586-025-09123-1","DOIUrl":"https://doi.org/10.1007/s00586-025-09123-1","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responsiveness of the Japanese version of the lumbar stiffness disability index.","authors":"Hidetaka Furuya, Kenji Hirohata, Sho Mitomo, Masahiro Hoshino, Tomoko Sakai, Tetsuya Jinno, Robert A Hart","doi":"10.1007/s00586-025-09120-4","DOIUrl":"https://doi.org/10.1007/s00586-025-09120-4","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to investigate the psychometric characteristics of the Japanese version of the Lumbar Stiffness Disability Index (J-LSDI) in patients undergoing lumbar spinal surgery, with a focus on its responsiveness and minimal clinically important differences (MCID).</p><p><strong>Methods: </strong>This prospective, single-institution cohort study enrolled adult individuals diagnosed with degenerative spinal pathologies who underwent surgical intervention approximately 1 year prior inclusion in the study. Participants were stratified into three groups according to the number of lumbar segments included in the arthrodesis construct: Group 1 (no fusion or single-level fusion); Group 2 (fusion across two to four levels); and Group 3 (fusion involving five or more levels). Within the distribution-based framework, responsiveness was quantified using effect size (ES) and standardized response mean (SRM). Areas under the receiver operating characteristic curves (AUCs) and MCID were determined for participants who reported either \"minimal\" or \"moderate\" improvement.</p><p><strong>Results: </strong>A total of 488 participants completed the J-LSDI at baseline and 1 year. In Group 1, the LSDI scores improved from preoperatively to postoperatively, with moderate ES and SRM values (ES = 0.78; SRM = 0.59). In Group 2, the preoperative and postoperative LSDI scores did not differ, with low ES and SRM values (ES = 0.13; SRM = 0.12). In Group 3, the LSDI scores worsened from preoperatively to postoperatively, with high ES and SRM values (ES = 1.20; SRM = 0.90). The optimal cutoff points for the MCID in Groups 1, 2, and 3 were - 8.0, 0.2, and 17.1, respectively. The AUCs for the MCID in Groups 1, 2, and 3 were 0.72, 0.73, and 0.76, respectively, indicating moderate accuracy. Between-group analysis of variance revealed no significant differences in preoperative LSDI scores (p = 0.40), while significant differences were observed in postoperative scores at 1 year (p < 0.01).</p><p><strong>Conclusion: </strong>This study underscores the clinical relevance and measurement reliability of the J-LSDI as an effective tool for evaluating the functional impact of spinal stiffness on activities of daily living among Japanese patients, in both the preoperative and postoperative phases of spinal surgery.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel dura splitting technique for surgical resection of anterior spinal meningioma: a case series and systematic review of the literature.","authors":"Abdurrahim Elashaal, Abdalhaleem Ibdah, Atef Hulliel, Asem Almomani","doi":"10.1007/s00586-025-09079-2","DOIUrl":"https://doi.org/10.1007/s00586-025-09079-2","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel artificial Intelligence-Based model for automated Lenke classification in adolescent idiopathic scoliosis.","authors":"Kunjie Xie, Suping Zhu, Jincong Lin, Yi Li, Jinghui Huang, Wei Lei, Yabo Yan","doi":"10.1007/s00586-025-09106-2","DOIUrl":"https://doi.org/10.1007/s00586-025-09106-2","url":null,"abstract":"<p><strong>Purpose: </strong>To develop an artificial intelligence (AI)-driven model for automatic Lenke classification of adolescent idiopathic scoliosis (AIS) and assess its performance.</p><p><strong>Methods: </strong>This retrospective study utilized 860 spinal radiographs from 215 AIS patients with four views, including 161 training sets and 54 testing sets. Additionally, 1220 spinal radiographs from 610 patients with only anterior-posterior (AP) and lateral (LAT) views were collected for training. The model was designed to perform keypoint detection, pedicle segmentation, and AIS classification based on a custom classification strategy. Its performance was evaluated against the gold standard using metrics such as mean absolute difference (MAD), intraclass correlation coefficient (ICC), Bland-Altman plots, Cohen's Kappa, and the confusion matrix.</p><p><strong>Results: </strong>In comparison to the gold standard, the MAD for all predicted angles was 2.29°, with an excellent ICC. Bland-Altman analysis revealed minimal differences between the methods. For Lenke classification, the model exhibited exceptional consistency in curve type, lumbar modifier, and thoracic sagittal profile, with average Kappa values of 0.866, 0.845, and 0.827, respectively, and corresponding accuracy rates of 87.07%, 92.59%, and 92.59%. Subgroup analysis further confirmed the model's high consistency, with Kappa values ranging from 0.635 to 0.930, 0.672 to 0.926, and 0.815 to 0.847, and accuracy rates between 90.7 and 98.1%, 92.6-98.3%, and 92.6-98.1%, respectively.</p><p><strong>Conclusion: </strong>This novel AI system facilitates the rapid and accurate automatic Lenke classification, offering potential assistance to spinal surgeons.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No long term benefit of decompression of a borderline lumbar spinal stenosis level adjacent to a more stenotic index level.","authors":"Erland Hermansen, Eric Franssen, Tor Åge Myklebust, Kari Indrekvam, Ivar Magne Austevoll, Christian Hellum, Sara Tronstad, Kjersti Storheim, Jørn Aaen, Hasan Banitalebi, Jens Ivar Brox, Trond Ottar, Tore K Solberg, Helena Brisby","doi":"10.1007/s00586-025-09113-3","DOIUrl":"https://doi.org/10.1007/s00586-025-09113-3","url":null,"abstract":"<p><strong>Purpose: </strong>Lumbar spinal stenosis (LSS) frequently involves multiple levels of the spine. Whether to perform single-level decompression (SLD) or multi-level decompression (MLD) in patients with at least one borderline stenotic level adjacent to the primary (index) level, remains debated. Short-term follow-up studies show comparable outcomes for both strategies. This study aimed to assess five-year outcomes in patients with adjacent borderline stenosis.</p><p><strong>Material: </strong>All participants were recruited from the NORDSTEN-SST. Patients with a preoperative adjacent borderline stenosis, defined as Schizas grade B or C, in addition to the index level, were included in the study. The cohort was divided into two groups based on the type of surgical intervention: SLD or MLD. Baseline characteristics and clinical outcomes were recorded for both groups, with follow-up conducted five years postoperatively. Subgroup analysis based on the Schizas grade in the adjacent level were also performed.</p><p><strong>Results: </strong>Out of 437 patients in the NORDSTEN-SST, the 222 with borderline adjacent stenosis were included. Among these, 114 underwent SLD, while 108 underwent MLD. Baseline characteristics were comparable between groups. Mean change in ODI-score was - 16.0 (95% CI -18.9-12.9) for the SLD group and - 18.6 (95% CI -22.1-15.1) for the MLD group, p = 0.26. Subgroup analyses revealed no significant differences between groups in clinical outcomes or need for subsequent spinal surgeries.</p><p><strong>Conclusion: </strong>In this observational study, five-year clinical outcomes in patients operated for lumbar spinal stenosis with a significant stenotic index level were not influenced by additional decompression of preoperative adjacent borderline stenotic levels.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research on a deep learning-based model for measurement of X-ray imaging parameters of atlantoaxial joint.","authors":"Yuhua Wu, Yuwen Zheng, Jinping Zhu, Xiaofei Chen, Fuwen Dong, Linyang He, Jinyang Zhu, Guohua Cheng, Ping Wang, Sheng Zhou","doi":"10.1007/s00586-025-09075-6","DOIUrl":"https://doi.org/10.1007/s00586-025-09075-6","url":null,"abstract":"<p><strong>Purpose: </strong>To construct a deep learning-based SCNet model, in order to automatically measure X-ray imaging parameters related to atlantoaxial subluxation (AAS) in cervical open-mouth view radiographs, and the accuracy and reliability of the model were evaluated.</p><p><strong>Methods: </strong>A total of 1973 cervical open-mouth view radiographs were collected from picture archiving and communication system (PACS) of two hospitals(Hospitals A and B). Among them, 365 images of Hospital A were randomly selected as the internal test dataset for evaluating the model's performance, and the remaining 1364 images of Hospital A were used as the training dataset and validation dataset for constructing the model and tuning the model hyperparameters, respectively. The 244 images of Hospital B were used as an external test dataset to evaluate the robustness and generalizability of our model. The model identified and marked landmarks in the images for the parameters of the lateral atlanto-dental space (LADS), atlas lateral mass inclination (ALI), lateral mass width (LW), axis spinous process deviation distance (ASDD). The measured results of landmarks on the internal test dataset and external test dataset were compared with the mean values of manual measurement by three radiologists as the reference standard. Percentage of correct key-points (PCK), intra-class correlation coefficient (ICC), mean absolute error (MAE), Pearson correlation coefficient (r), mean square error (MSE), root mean square error (RMSE) and Bland-Altman plot were used to evaluate the performance of the SCNet model.</p><p><strong>Results: </strong>(1) Within the 2 mm distance threshold, the PCK of the SCNet model predicted landmarks in internal test dataset images was 98.6-99.7%, and the PCK in the external test dataset images was 98-100%. (2) In the internal test dataset, for the parameters LADS, ALI, LW, and ASDD, there were strong correlation and consistency between the SCNet model predictions and the manual measurements (ICC = 0.80-0.96, r = 0.86-0.96, MAE = 0.47-2.39 mm/°, MSE = 0.38-8.55 mm²/°², RMSE = 0.62-2.92 mm/°). (3) The same four parameters also showed strong correlation and consistency between SCNet and manual measurements in the external test dataset (ICC = 0.81-0.91, r = 0.82-0.91, MAE = 0.46-2.29 mm/°, MSE = 0.29-8.23mm²/°², RMSE = 0.54-2.87 mm/°).</p><p><strong>Conclusion: </strong>The SCNet model constructed based on deep learning algorithm in this study can accurately identify atlantoaxial vertebral landmarks in cervical open-mouth view radiographs and automatically measure the AAS-related imaging parameters. Furthermore, the independent external test set demonstrates that the model exhibits a certain degree of robustness and generalization capability under meet radiographic standards.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar discal cysts: a systematic literature review of diagnostic features and treatment strategies.","authors":"Edoardo Agosti, Lucio De Maria, Francesco Belotti, Enza Gatti, Marco Bruzzone, Paolo Amaddeo, Gianandrea Bellini, Riccardo Bergomi, Marco Fontanella, Nazzareno Fagoni, Claudio Cornali","doi":"10.1007/s00586-025-09059-6","DOIUrl":"https://doi.org/10.1007/s00586-025-09059-6","url":null,"abstract":"<p><strong>Purpose: </strong>Discal cysts are epidural masses connected to the intervertebral disk, primarily affecting younger individuals. Distinguishing discal cysts from other cystic masses within the epidural space is challenging due to overlapping clinical symptoms and neuroimaging characteristics. This systematic review aims to analyze the diagnostic features and management strategies of lumbar discal cysts.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted following PRISMA guidelines. Relevant studies published between January 1990 and July 2023 were included. Data on diagnostic features, management strategies, and outcomes were extracted. The quality of included studies was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>This systematic review examined a total of 52 articles and 118 cases of discal cysts, including one institutional case. The median age of the patients was 30 years, with a higher prevalence of males. The median follow-up period was 12 months. The most common symptoms reported were leg pain (87.3%) and low back pain (71.2%). Physical examination findings were positive in 45.5% of patients, including hypoesthesia (23.2%), leg weakness (18.8%), and positive straight leg raise test (19.6%). All patients underwent spinal lumbar MRI, which revealed discal nodularity that appeared hypointense in T1-weighted sequences with cystic wall enhancement and hyperintense in T2-weighted sequences. Contrast-enhanced MRI showed enhancement of the cyst wall in the cases where it was performed. Discal cysts were mainly at the L4-L5 level (44.9%) and L5-S1 level (26.3%), with a ventrolateral (94.9%), ventral (4.2%), or lateral position (0.8%). Various treatment modalities were used, including conservative management (5.9%), microscopic cyst resection and discectomy (32.2%), microscopic cyst resection (28.8%), microendoscopic cyst resection (22.1%), and CT-guided cyst aspiration (11%). The majority of patients experienced progressive improvement of symptoms.</p><p><strong>Conclusion: </strong>Discal cysts generally present with low back and radicular pain and can be diagnosed using MRI. Differential diagnoses must be considered to ensure accurate diagnosis and appropriate management. Conservative treatment is typically the initial approach, while surgical interventions are considered for refractory cases.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}